Speaker 1: Hi. This is Laura Vandercamp. I'm a mother of five,
Speaker 1: an author, journalist, and speaker.
Speaker 2: And this is Sarah Hartunger. I'm a mother of three,
Speaker 2: a practicing physician and blogger. On the side, we are
Speaker 2: two working parents who love our careers and our families.
Speaker 1: Welcome to best of both worlds. Here we talk about
Speaker 1: how real women manage work, family, and time for fun.
Speaker 1: From figuring out childcare to mapping out long term career goals.
Speaker 1: We want you to get the most out of life.
Speaker 1: Welcome to best of both worlds. This is Laura. This
Speaker 1: episode is airing at the very end of January. In
Speaker 1: twenty twenty four, Sarah is going to be interviewing doctor
Speaker 1: Gillian Goddard, who has been a prior guest on the show.
Speaker 1: She was talking about her life as a practicing physician
Speaker 1: in New York and as she's raising four children. She
Speaker 1: particularly talked about having op pars with her family and
Speaker 1: how that had worked as a childcare solution. But she's
Speaker 1: back because she has a new newsletter that is out
Speaker 1: very recently called The Hot Flash, dealing with medical issues
Speaker 1: associated with women who are about our age. Sarah, as
Speaker 1: we hit our mid forties, so looking at issues for
Speaker 1: women in their forties. So why don't you tell us
Speaker 1: a little bit about what you and Jillian cover in this.
Speaker 2: Yeah, so this has been requested many times. We had
Speaker 2: a prior guest shout out to doctor Laura Erdman who
Speaker 2: talked about some of these topics, kind of focusing on
Speaker 2: the obigui in side. But doctor Goddard is an endecnologist,
Speaker 2: so kind of like a different medical field and perspective,
Speaker 2: and great timing since she is starting this amazing newsletter
Speaker 2: which I think came out last week when this episode airs,
Speaker 2: and it's part of Emily Oster's parent Data collection of newsletters,
Speaker 2: so it's going to be awesome. And yeah, I was
Speaker 2: super curious about a lot of things, including whether or
Speaker 2: not I'm in perimenopause spoiler. I think the answer is no.
Speaker 2: But it was a really it was a really, really
Speaker 2: fun conversation. If you are triggered by discussion of cycles
Speaker 2: and fertility and other things like that, this may be
Speaker 2: an episode to skip. We do talk about those kinds
Speaker 2: of things, So yeah, I guess it does make sense
Speaker 2: for me to give that as a little bit of
Speaker 2: a trigger warning. You can check out all of our
Speaker 2: prior episodes if you need something else to listen to
Speaker 2: this week.
Speaker 1: Yeah, but very exciting because this is a topic that
Speaker 1: I know a lot of our listeners are curious about
Speaker 1: as we get a little bit older and watch our
Speaker 1: bodies change again, it's just a constant thing of figuring
Speaker 1: out what's going on, and many of us are helping
Speaker 1: our teen daughters through the first part of that to
Speaker 1: sort of stage, but we are entering into the other
Speaker 1: one of it. So we'll be excited to hear what
Speaker 1: Jillian Goddard has to say and excited that this is
Speaker 1: a topic that more people are talking about and is
Speaker 1: coming into the cultural consciousness.
Speaker 3: So let's hear what she has to say.
Speaker 2: I am so excited to welcome doctor Gillian Goddard to
Speaker 2: Best of Both Worlds for this second time. But Jillian
Speaker 2: was on this podcast previously, not as physician Gillian. She
Speaker 2: was on as parent Gillian, talking all about the O
Speaker 2: pair lifestyle. But we decided we needed to have her back,
Speaker 2: and we beg to have her back because there have
Speaker 2: been so many questions from our audience about perimenopause and hormones,
Speaker 2: and doctor Goddard happens to be an expert in that field.
Speaker 2: She also was an attendee of Bestly Plans Live. Had
Speaker 2: so much fun hanging out with me and Laura in
Speaker 2: Fort Lauderdale last fall. And she's an endocrinologist in private
Speaker 2: practice and the author of hot Flash, which is the
Speaker 2: best name ever. That is a newsletter from Parent Data
Speaker 2: by Emily, auser who we've also had on the podcast.
Speaker 2: So welcome, doctor Gillian Goddard.
Speaker 3: Oh, I thank Sarah. It's so glad to be back
Speaker 3: on Best of Both Worlds.
Speaker 4: I am a very regular listener, so it's great to
Speaker 4: be here again.
Speaker 3: I love it.
Speaker 2: We love having our listeners and Patreon members and just
Speaker 2: people who have kind of gotten to know the show
Speaker 2: really well on It always feels really really smooth, So
Speaker 2: super excited with the conversation. Plus I'm personally excited about
Speaker 2: the topic. So because it's actually funny, I will say, like,
Speaker 2: people think I know adult in new chronology, and I
Speaker 2: know very very little adult in necronology. Someone asked me
Speaker 2: for something about menopause, and I'm like, you realize my
Speaker 2: patients go up to like age twenty. I mean, yes,
Speaker 2: there are some patients that have sort of menopausal scenarios.
Speaker 2: For different reasons, but it's not my forte Okay. So
Speaker 2: with all that said, what is the difference between menopause
Speaker 2: perimenopause and like, is there even like a perimenopause before that,
Speaker 2: like take us through the journey. Sure, So I think
Speaker 2: that this is really.
Speaker 4: Important to make a distinction among all these different phases
Speaker 4: that our bodies go through in our forties and fifties.
Speaker 3: A lot of my patients come.
Speaker 4: In and say they're having all these symptoms and they
Speaker 4: thought they were having perimenopause, but they went to their gynecologists,
Speaker 4: and their gynecologists checked their labs and we're like, no,
Speaker 4: you're not in perimenopause. And then they're like, well, then
Speaker 4: why do I feel so crummy? And so I think
Speaker 4: it is a really important thing to sort of make
Speaker 4: all these distinctions. So let's just talk through them from
Speaker 4: the beginning. So you go from being in your thirties
Speaker 4: and you're having regular periods and you're having your babies
Speaker 4: and your breastfeeding and life is going on as normal.
Speaker 4: And if you're anything like me, you hit forty and
Speaker 4: you are.
Speaker 3: Like, forties are going to be the best. I don't
Speaker 3: have little babies.
Speaker 4: I'm going to sleep at night, I'm going to feel amazing,
Speaker 4: and you know, there's no diapers, there's no breastfeeding, there's
Speaker 4: none of that. And what I found, and what a
Speaker 4: lot of my patients mind.
Speaker 3: Is sure that that works great for.
Speaker 4: A few years, and then all of a sudden, you
Speaker 4: start having like weird headaches and all your periods change,
Speaker 4: and you're not sleeping at night, and none of it
Speaker 4: makes any sense. And what that actually is typically is
Speaker 4: something called the late reproductive phase. So this is a
Speaker 4: phase that typically starts for women in their early forties
Speaker 4: and can go on for five years, maybe even more.
Speaker 4: And what defines the late reproductive phase is that you
Speaker 4: are still having regular periods, but your cycles are changing.
Speaker 3: So even though your period is about the.
Speaker 4: Same length every month, it might go from being thirty
Speaker 4: two days to twenty eight days to twenty six days,
Speaker 4: and along with that you can have heavier periods and
Speaker 4: you can have a lot more symptoms. Some women even
Speaker 4: get more irritable or don't sleep as well. A lot
Speaker 4: of women got hormonal headaches in this time period, and
Speaker 4: some women even get hot flushes, but they only get
Speaker 4: them around their period when our hormones drop and the
Speaker 4: reason all this happens in our forties is because unfortunately,
Speaker 4: as we get into our forties, we still have eggs in.
Speaker 3: Our own but they're not like they're like the last
Speaker 3: guy's picked.
Speaker 4: They're not the most amazing eggs, and it takes a
Speaker 4: lot of stimulus or juice as it were, from our
Speaker 4: pituitary gland to get those eggs to be ready to ovulate.
Speaker 4: So we have this hormone called FSH or follicle stimulating hormone,
Speaker 4: and it goes up higher, and that hormone makes our
Speaker 4: estrogen go up higher, and high estrogen is fine, but
Speaker 4: then that estrogen has to come back down, and it's
Speaker 4: actually the drop that makes us feel really, really grummy.
Speaker 4: And so even though our estrogen levels are rising and
Speaker 4: falling at the same times of the month as they
Speaker 4: used to, they're going higher and they're falling lower, and
Speaker 4: all of that makes us symptomatic. So we trundle along
Speaker 4: with that for five years, and then we typically see
Speaker 4: people transition to perimenopause. Perimenopause is when our cycle length
Speaker 4: starts to vary. So maybe we had gone down to
Speaker 4: having a twenty six day cycle, but it was a
Speaker 4: twenty six day cycle every single month. Perimenopause is a
Speaker 4: twenty two day cycle followed by a forty three day
Speaker 4: cycle followed by a thirty four day cycle, And the
Speaker 4: technical definition is that there's a greater than seven day
Speaker 4: variability from cycle to cycle. And so again, we may
Speaker 4: be ovulating, we may be having periods intermittently.
Speaker 3: They might still feel.
Speaker 4: Kind of regular, but they're much more all over the
Speaker 4: place than they used to be. And we might go
Speaker 4: through times when we feel fine, and we might go
Speaker 4: through times when we're having lots of symptoms like hot flushes,
Speaker 4: night sweats, eared ability, dissleep disruption and all those things.
Speaker 3: Are not so fun.
Speaker 4: And then the cycles tend to space out further and
Speaker 4: further and further, and eventually you will have.
Speaker 3: A last period and enter menopause.
Speaker 4: The funny thing about menopause, though, is you can only
Speaker 4: diagnose it in retrospect, so you have to go twelve
Speaker 4: months without having a period before you can officially say
Speaker 4: you're in menopause. So if you go eleven months and
Speaker 4: then you have a period, you're still in perimenopause.
Speaker 2: The funny thing about that is like the idea that
Speaker 2: you would just never know when it's the last one.
Speaker 2: I never really thought about that, But I don't know
Speaker 2: how I feel about that.
Speaker 5: That has some really important implications too, because there are
Speaker 5: some studies that show that at least twenty five percent
Speaker 5: of cycles that are more than six months long, So
Speaker 5: say you haven't had a period in six months and
Speaker 5: then all of a sudden you have a period, twenty
Speaker 5: five percent of those cycles you.
Speaker 4: Actually ovulate, which I think has really important implications when
Speaker 4: you're thinking about things like contraception. The other thing is,
Speaker 4: we used to think that this was like a very
Speaker 4: orderly progression from the late reproductive phase to perimenopause to menopause,
Speaker 4: and it turns out actually more than half of women
Speaker 4: seesaw between the late reproductive phase and perimenopause, and that
Speaker 4: can go on for quite a while. And so just
Speaker 4: because your cycles start to lengthen out doesn't mean that
Speaker 4: all of a sudden you won't start having regular twenty
Speaker 4: eight day cycles.
Speaker 2: Again, that doesn't seem fair, but good to know. So
Speaker 2: question is there like a I don't know a way
Speaker 2: of predicting when this is going to happen to you
Speaker 2: based on medical history. Do people who start their medicare
Speaker 2: earlier tend to have menopause earlier or is it more
Speaker 2: related to like if your mother had earlier menopause, then
Speaker 2: you will as well.
Speaker 4: So we used to think it was hereditary, but actually
Speaker 4: newer cities suggests that there's not really a hereditary connection.
Speaker 3: It would make sense if you.
Speaker 4: Started having periods earlier that you would go through menopause earlier,
Speaker 4: but that's not actually true. The late bloomers actually go
Speaker 4: through menopause earlier, and the early bloomers have period typically
Speaker 4: have periods for longer, and so it doesn't make a
Speaker 4: lot of sense a lot of times. But so yeah,
Speaker 4: so there's not a lot of prediction, So you just
Speaker 4: get way you people super interesting gassing it. So okay,
Speaker 4: so what we heard about hot flashes, we heard about
Speaker 4: sleep disruption, irritability, things like pm d D I'm guessing
Speaker 4: become more common in perimenopause. But one thing that women
Speaker 4: tend to talk about a lot is weight gain. Is
Speaker 4: that a myth is that more related to age. Is
Speaker 4: there a hormonal component, what drives that and what can
Speaker 4: counteract it? Since for most people it's probably not the
Speaker 4: most welcome visitor. Yeah, so waking is something that women
Speaker 4: really struggle with I feel like not a day passes
Speaker 4: in my office where someone doesn't come in wanting to
Speaker 4: talk about perimenopausal weight gain.
Speaker 3: It is real.
Speaker 4: There are studies that will follow women longitudinally over time
Speaker 4: and show that women do, on average, gain about four
Speaker 4: pounds over six years in the perimenopausal time period. It
Speaker 4: is interesting largely in the mid section. So if you
Speaker 4: look at something we call waste circumference, where you literally
Speaker 4: just measure around somebody's waste in over and do that serially,
Speaker 4: you see that women do tend to have an increase
Speaker 4: in waste circumference. What's really interesting about it, though, is
Speaker 4: waste circumference seems to be something that increases and then
Speaker 4: levels out, but overall weight continues to creep up over time,
Speaker 4: which means that you're then gaining weight in other places,
Speaker 4: not just in your mid section. The issue though, is
Speaker 4: that when you gain weight in your mid section, it
Speaker 4: has implications for your metabolic health, so blood pressure, diabetes,
Speaker 4: cardiovascular disease, and so that's why we care about it
Speaker 4: beyond just vanity, and there are studies that look at
Speaker 4: how it's tied hormonally.
Speaker 3: Estrogen is a player here for sure.
Speaker 4: The DroPIN estrogen in the perimenopausal and postmenopausal years, does
Speaker 4: it shifts body composition so we are able to gain
Speaker 4: more fat and we lose a small but significant amount
Speaker 4: of muscle mass. And then the other thing that's been
Speaker 4: shown to be have implications as actually the hormone FSH,
Speaker 4: which I mentioned earlier. So FSH, which is follicle stimulating hormone,
Speaker 4: is a hormone made in our pituitary glance to trigger ovulation,
Speaker 4: and after we go through menopause, when we don't have
Speaker 4: any eggs left to ovulate, our pituitary gland doesn't know
Speaker 4: that and so it just keeps making FSH and FSH
Speaker 4: does seem to have implications for perimenopausal we gain as well.
Speaker 2: Oh, that's interesting. It would be a hard study to
Speaker 2: do because it seems like it would be a confounder,
Speaker 2: but I'm sure they figured out ways to control for it.
Speaker 2: And for those listening to this who are like FSH,
Speaker 2: why do I know that that if you go to
Speaker 2: your PCP and want a blood test for menopause, like
Speaker 2: that's typically the one they'll do. I'm not saying that's
Speaker 2: the way to diagnose menopauses. Doctor Goddard said, but for
Speaker 2: those that got that diagnosis or not from their primary,
Speaker 2: that maybe where things started, because it can be a
Speaker 2: marker that at least send you down some path or another. Okay,
Speaker 2: so we're going to talk about what will counteract that
Speaker 2: weight gain. Perhaps in just a moment, we will be
Speaker 2: right back. Okay, we're back. So understanding that both a
Speaker 2: drop and estrogen as well as high FSH levels, plus
Speaker 2: maybe the impact of body composition changes, because that's going
Speaker 2: to then change your basal metabolic rate. I would assume drives.
Speaker 2: The weight gain that is seen doesn't sound like a
Speaker 2: huge amount of weight gain, but kind of like a
Speaker 2: slow and steady weight gain during those menopausal years and
Speaker 2: perimenopausal years. So what do you tell your patients when
Speaker 2: they if and when they are looking for something to
Speaker 2: counteract that?
Speaker 4: Sure?
Speaker 3: I mean, I think it depends on.
Speaker 4: The degree of wegain you're seeing and what your risk
Speaker 4: factors for other diseases are. So if you are someone
Speaker 4: with a with sort of a healthy weight and you're
Speaker 4: seeing a modest wegain, and to me, a modest weaging
Speaker 4: would be you know, five pounds, even ten pounds, Although
Speaker 4: I appreciate that that feels like a lot to people.
Speaker 4: Then really sort of lifestyle factors are the key, and
Speaker 4: I think the biggest key is fighting the loss of
Speaker 4: muscle mass. And this is where being sure that you're
Speaker 4: doing strength training is absolutely key, because if you can
Speaker 4: fight that loss of muscle mass, you can help maintain
Speaker 4: a healthier body composition. And when you maintain a healthier
Speaker 4: body composition, you don't have to the math of calories
Speaker 4: in versus calories outworks much more in your favor because
Speaker 4: your body naturally is burning more calories and it means
Speaker 4: that you can consume a more typical diet and.
Speaker 3: Maintain your weight.
Speaker 2: That makes sense.
Speaker 4: It's also really important for bone density, which also decreases
Speaker 4: in menopause, and so weight lifting is only going to
Speaker 4: do positive things for you. In women who are looking
Speaker 4: at a more significant weight gain or are looking at
Speaker 4: maybe they've become pre diabetic or even diabetic, there are
Speaker 4: blood pressures going up where there's really health concerns In
Speaker 4: addition to waking. This is where we might think about
Speaker 4: medications depending on the degree of wakaingin. There are several
Speaker 4: medications that have been shown to be really effective, and
Speaker 4: some of the newer medications like wigov or zep bound
Speaker 4: can be really effective.
Speaker 3: For women in the perimenopausal years.
Speaker 4: I know that they've gotten a lot of press lately.
Speaker 4: They're sort of the medications du jure. But for women
Speaker 4: who've had really significant waking in midlife and who are
Speaker 4: seeing their blood sugars creep up and their cholesterol creep up,
Speaker 4: they really are a wonderful tool to help with that
Speaker 4: perimenopausal waking.
Speaker 2: Always nice to have more potential solutions, even if it's
Speaker 2: not always the solution for each person. All right, So
Speaker 2: moving on to contraception. For those who haven't, you mentioned
Speaker 2: that that earlier that sometimes your last period or close
Speaker 2: to your last period can be an ovulatory, which means
Speaker 2: you could get pregnant when you thought you were already
Speaker 2: in menopause, which is super interesting longtime listeners this show,
Speaker 2: I may know I got pregnant like between pregnancies, meaning
Speaker 2: like I had never I'd stopped breastfeeding, never had a
Speaker 2: cycle return, and then got pregnant before my cycle came back.
Speaker 2: So I guess on the very first ovulation between Adabel
Speaker 2: and Cameron, who are twenty two months apart, which for
Speaker 2: me was amazing. I was thrilled because I had had
Speaker 2: such infertility that I'm like, whoo, this is the best
Speaker 2: surprise ever. But I imagine that might not be the
Speaker 2: best surprise if you thought you were in menopause a
Speaker 2: little bit of potentially, I mean maybe it would.
Speaker 3: I don't want to judge.
Speaker 2: Maybe that that was very welcome, but if for some
Speaker 2: that's not the desired outcomes. So talk about contraceptive methods
Speaker 2: for those over the age of forty, And I guess
Speaker 2: one other side is that I personally have found that
Speaker 2: ocps do not agree with me anymore, even though I
Speaker 2: did rely on them for many years in my youth.
Speaker 4: Yeah, so I think you know, when I talked to
Speaker 4: my patients about contraception, I say a few things. The
Speaker 4: one is, because of what we just talked about, if
Speaker 4: you don't want to be pregnant, you should be using
Speaker 4: some form of contraception up until you are in menopause, and.
Speaker 3: Not only if you don't want to be pregnant.
Speaker 4: The eggs that we're ovulating at this point are not
Speaker 4: the again, they're not the champs, and so your risk
Speaker 4: of not just getting pregnant but then having a miscarriage
Speaker 4: is definitely there. And that's a lot to put your
Speaker 4: body through. So I do definitely recommend using a form
Speaker 4: of contraception. When I talk to patients about contraception, I
Speaker 4: like to think about what it can do for you,
Speaker 4: sort of beyond just keeping you from getting pregnant, and
Speaker 4: that can be different for everyone. Some of the forms
Speaker 4: of contraception that we don't think about when we're younger,
Speaker 4: that are irreversible or relatively irreversible, are great options when
Speaker 4: you're in your forties and fifties and you're done having kids.
Speaker 3: So I'm thinking about.
Speaker 4: Things like tubal ligation or sealpingektamy, which is actually removing
Speaker 4: the fallopian tubes completely. The benefit of that procedure is
Speaker 4: that it really reduces your risk of ovarian cancer.
Speaker 5: And so.
Speaker 3: If you're having a c section and you know it's
Speaker 3: your last.
Speaker 4: Baby and they're going to be in there anyway, like
Speaker 4: maybe a sell pingekt tomy would be the right choice
Speaker 4: for you. The other great option that doesn't involve you
Speaker 4: at all if you're the mother of your children is vasectomy.
Speaker 4: That is my favorite form of permanent contraception. Vaseectomy is
Speaker 4: basically you cut and tie off the tubes that carry
Speaker 4: sperm from the testicles. To the semen, and the semen
Speaker 4: doesn't look any different, doesn't seem any different. It just
Speaker 4: doesn't have sperm in it, which is great, and it's
Speaker 4: such a minor procedure. My husband knows that I share
Speaker 4: this information, but he had a sectam and went out
Speaker 4: to dinner that night and coached soccer the next day,
Speaker 4: and so really it was a big non event. The
Speaker 4: key with that sectimy is you do actually have to
Speaker 4: make sure he goes back and has the post procedure
Speaker 4: seem an analysis to make sure that it actually worked
Speaker 4: before you rely.
Speaker 3: On it for contraception.
Speaker 4: But then when we think about other forms of contraception
Speaker 4: that you may have used before, things like iud's and
Speaker 4: oral contraceptive pills, birth control pills are definitely still options.
Speaker 4: I think that there you want to really again think
Speaker 4: about what you're getting from it. So if your periods
Speaker 4: are really heavy and really causing problems from that perspective,
Speaker 4: and a progesterone eluding IUD might be a really like
Speaker 4: a marina or a Kaylina might be a really great
Speaker 4: option for you because they work by thinning the uterine
Speaker 4: lining and really really lighten up your periods. They also
Speaker 4: last you can keep your marina in for seven years now,
Speaker 4: so one or two marinas might get you from your
Speaker 4: last kid to menopause without a lot of fuss. I
Speaker 4: do actually still use a lot of birth control pills
Speaker 4: in women in their forties. We used to think that
Speaker 4: birth control pills were not safe after the age of
Speaker 4: thirty five. Those are like really old studies from the
Speaker 4: original birth control pills, which had pretty high.
Speaker 3: Doses of estrogen in them.
Speaker 4: I typically use the ultra lo doos pills in women
Speaker 4: in their forties, and those have been shown to be
Speaker 4: safe up until the average age of menopause, so early fifties.
Speaker 3: The key there.
Speaker 4: Though, is making sure that it's the right one for you,
Speaker 4: and the nice thing about it is if you are
Speaker 4: having a lot of symptoms like hot flushes or sleep disruption,
Speaker 4: they essentially act like hormone replacement therapy. They're the same
Speaker 4: hormones that are in hormone replacement therapy, just in a
Speaker 4: slightly higher dose, and.
Speaker 3: So you can get a lot of benefit there.
Speaker 4: You can also skip periods with the low dose birth
Speaker 4: control pills, which a lot of women find really really beneficial.
Speaker 3: The key though, is.
Speaker 4: Just to make sure that whatever you are using it's
Speaker 4: working for you, and that you're not just sticking with
Speaker 4: something because it's what you've always used when it maybe
Speaker 4: isn't working for you anymore. So reassessing like, well, I
Speaker 4: used to be on this pill, but maybe now a
Speaker 4: different pill would be the right choice because of the dose.
Speaker 4: Or I used to use a birth control pill, but
Speaker 4: now maybe a moreno would be the right choice. And
Speaker 4: so I think just being ready to kind of reassess
Speaker 4: and reconsider is key. The one thing I would say
Speaker 4: is while barrier methods can be great and are super reversible,
Speaker 4: they might not be the right choice if a pregnancy
Speaker 4: in your family would be catastrophic, because they do have
Speaker 4: a much higher failure rate. The beauty of things like
Speaker 4: IUDs and even sterilization procedures is they don't involve you
Speaker 4: doing anything. You go to the doctor, have something done,
Speaker 4: and you don't think about it, and so there's no
Speaker 4: there's not a lot of dependency on your sort of
Speaker 4: operating them appropriately.
Speaker 2: I mean you say barrier methods, I assume you mean,
Speaker 2: like you know, traditional condoms, but then there's also some
Speaker 2: newer there's also some newer medications that can be basically
Speaker 2: placed up there that kind of serve the barrier method
Speaker 2: that have gained popularity recently. Yeah, yeah, all right, so
Speaker 2: that is all about contraception, and yeah, I didn't mean
Speaker 2: to diss OCPS. I just tried two different ones and
Speaker 2: cured my migraines by stopping them all. And so the
Speaker 2: migraines were so bad and first went on for so
Speaker 2: long on two different medications that I'm personally not willing
Speaker 2: to revisit it. But to each their own. And I
Speaker 2: not have ever had migraines if I didn't have a
Speaker 2: probably predisposition to them. So all of that said, great
Speaker 2: to have again, so many different options to think about,
Speaker 2: So how about HRT in those like when do you
Speaker 2: start thinking about hormone replacement therapy? And I feel like
Speaker 2: I trained in medical school during the Women's Health Initiative
Speaker 2: years and we were like HRT is charitable and nobody
Speaker 2: should ever use it and it's just killing people. And
Speaker 2: then it seems like finally the pendulum has really swung
Speaker 2: in the other direction. And I would love you to
Speaker 2: talk about how that has shifted and what kinds of
Speaker 2: options are out there for people who might find themselves
Speaker 2: in perimenopause and having symptoms.
Speaker 4: Sure, So I think the decision about whether to use
Speaker 4: hormone replacement therapy versus something like a birth control pill
Speaker 4: really depends on how regular your periods are and kind
Speaker 4: of where you are in your life cycle. Having a
Speaker 4: period every six months and you're having tons of hot flushes,
Speaker 4: hormone replacement therapy is probably the better choice. If you're
Speaker 4: forty five and you're still having super regular periods, probably
Speaker 4: a birth control pill is the better option. The key
Speaker 4: with hormone replacement therapy, though, is if you're having symptoms,
Speaker 4: talk to your doctor about them, because there's just really
Speaker 4: no reason to be miserable through menopause.
Speaker 3: I think a lot of women.
Speaker 4: Also came of age during the Women's Health Initiative, and
Speaker 4: maybe they weren't in medical school like you and I were,
Speaker 4: but they were seeing news articles and hearing their moms
Speaker 4: talk about menopause and sort of getting the same message
Speaker 4: that we were getting. And unfortunately, it's taken in twenty
Speaker 4: years of a lot of women suffering unnecessarily to really
Speaker 4: get the pendulum swinging back in the right direction. And
Speaker 4: I think that if you are having hot flushes with.
Speaker 3: Sleep disruption, mood changes.
Speaker 4: It's all fodder for discussion with your GYN or primary
Speaker 4: care doctor because all those things can be managed with
Speaker 4: hormone replacement therapy. And actually part of the reason the
Speaker 4: pendulum is swung back is because, well, we can talk
Speaker 4: about the Women's Health Initiative study all day, and I
Speaker 4: think everyone might be bored except for you and me.
Speaker 3: But there's been a.
Speaker 4: Lot of new data that's come out showing that there
Speaker 4: may be significant benefits to hormone replacement therapy. There's some
Speaker 4: new studies about dementia risk, especially in people at high
Speaker 4: risk for dementia, and hormone replacement therapy. There's certainly positive
Speaker 4: effects with hormone replacement therapy and bone and using hormone
Speaker 4: replacement therapy in your fifties may actually be beneficial from
Speaker 4: a cardiovascular point of view, which is directly as to
Speaker 4: what came out in the Women's Health Initiative, and that
Speaker 4: was probably because of their patient population. So I think
Speaker 4: that we're really rethinking hormone replacement therapy. We also use
Speaker 4: it really differently now, so we don't do a lot
Speaker 4: of oral hormone replacement therapy anymore, although those options are
Speaker 4: still out there. We do a lot with transdermal estrogen,
Speaker 4: which means you put the estrogen on your skin and
Speaker 4: it goes in through your skin. And there are patches
Speaker 4: and gels and all kinds of different options for getting
Speaker 4: the hormones into you in a way that seems to
Speaker 4: be more beneficial in the perimenopausal years.
Speaker 3: That is awesome, all right.
Speaker 2: Now on to a question I get from patients as well,
Speaker 2: and I'm sure it's not uncommon the adult population, but
Speaker 2: what are the natural things one can do to combat
Speaker 2: perimenopausal symptoms or menopausal symptoms? Are there supplements that are recommended?
Speaker 2: I feel like, remember what it was? There was one
Speaker 2: I heard about for a while, but now I feel
Speaker 2: like I haven't heard about it. And then not to
Speaker 2: like open Pandora's box, but kind of similar lines. What
Speaker 2: about bioidentical hormones as well? As I feel like I've
Speaker 2: heard a lot of women taking small doses of topical testosterone,
Speaker 2: So I would love comments on all of that supplements,
Speaker 2: natural hormones, bioidenticals, and testosterone.
Speaker 3: So let's start with supplements.
Speaker 4: The main supplements that people talk about are soy phido
Speaker 4: estrogens and supplements like black cohosh. There's zero data that
Speaker 4: they actually do anything. I wish they did because people
Speaker 4: really would like an option like that, But there's really
Speaker 4: when you drill down into the studies, there's not a
Speaker 4: lot of there there, So I would skip it. If
Speaker 4: you're looking for a non hormonal treatment, those do exist
Speaker 4: at this point, and so I would go there before
Speaker 4: I went with one of the sort of supplement options.
Speaker 4: The one supplement I do recommend my page it's a
Speaker 4: lot though, for sleep disruption and hormonal headaches is magnesium.
Speaker 4: Magnesium is a great option for women. You take it
Speaker 4: at bedtime, it actually helps you with sleep and it
Speaker 4: reduces hormonal headaches as well. And there is actual data
Speaker 4: supporting that the bioidenticals are really funny product because what
Speaker 4: they are essentially is the same estrogen and progestins that
Speaker 4: you can get in a commercially available hormone replacement patch,
Speaker 4: but made in a compounding pharmacy, usually in a lotion
Speaker 4: or cream that you put on topically. The issue there
Speaker 4: is that pharmaceutical companies are required to go through all
Speaker 4: of these checks with the FDA to quality assurance to
Speaker 4: make sure that what you're getting in your estrogen patch
Speaker 4: or in your there's a product called divvy jail, which
Speaker 4: is in gel that those products have in them exactly
Speaker 4: what they say they have in them, and nothing else
Speaker 4: and nothing else. Compounding pharmacies really vary in their quality,
Speaker 4: and it really varies even from batch to batch whether
Speaker 4: you're getting exactly what you think you're getting. Add to
Speaker 4: that that compounding pharmacies typically are not covered by insurance,
Speaker 4: so bioidenticals are typically.
Speaker 3: An out of pocket purchase.
Speaker 4: And I've had patients come in and they've been spending
Speaker 4: hundreds of dollars a month on bioidentical hormones, and it
Speaker 4: turns out that if they used a pharmaceutical product approved
Speaker 4: by the FDA, that it would be covered by their
Speaker 4: insurance and they'd be paying like ten dollars a month.
Speaker 3: So I really caution people to.
Speaker 4: Think long and hard about bioidenticals because I'm not sure
Speaker 4: that you really get a lot of value for the
Speaker 4: money that you're spending, and you may not even be
Speaker 4: getting what you think you're getting.
Speaker 2: Okay.
Speaker 4: Testosterone is a really fun new addition to.
Speaker 3: Hormone replacement therapy.
Speaker 4: So women have testosterone, they just have it in much
Speaker 4: smaller amounts than men do orders of magnitude smaller, so
Speaker 4: men have testosterone in the hundreds. Women during their reproductive
Speaker 4: lives typically of testosterones around twenty and some women after
Speaker 4: menopause their testosterone or in perimenopause their testosterone drops quite low.
Speaker 3: Other women have the opposite problem.
Speaker 4: Their testosterone levels get high and they get all scient.
Speaker 3: Types of symptoms that they don't like from that.
Speaker 4: For the women who get low testosterones, they can have fatigue,
Speaker 4: low libido. A lot of times they can't even describe it.
Speaker 4: They just don't feel good. There can be a lot
Speaker 4: of mood effects that women have, and if testosterone is low.
Speaker 3: Then giving a little baby.
Speaker 4: Dose of a testosterone gel can actually be life changing
Speaker 4: for some women. So if we think about sort of
Speaker 4: again orders of magnitude, testosterone is manufactured for men and
Speaker 4: it comes in little packets that a man uses one
Speaker 4: packet each day. My patients, I typically start them on
Speaker 4: a fifth of a packet, so a one packet lasts
Speaker 4: them five applications, and they do it every other day
Speaker 4: or three days a week, and so that tiny, tiny
Speaker 4: bit of testosterone is enough to make them feel much better.
Speaker 4: It is not typically covered by insurance for women, even
Speaker 4: though there's lots of studies looking at off label use
Speaker 4: of testosterone and women and it does seem to show benefit.
Speaker 4: It is something that women typically have to pay out
Speaker 4: of pocket for, but a thirty day supply for a
Speaker 4: man lests the woman the way I described it for
Speaker 4: almost a year, and testosterone gel is generic at this point,
Speaker 4: so it tends out to be a big investment when
Speaker 4: you think about amateurizing it over the course of the year.
Speaker 3: Totally cool.
Speaker 2: And I feel like that's one that definitely, like ten
Speaker 2: years ago, nobody was talking about and now it's out there,
Speaker 2: so who knows what else will be coming down the pike,
Speaker 2: probably even more exciting options, because I feel like this
Speaker 2: is an area that just was kind of ignor well,
Speaker 2: I guess I wasn't ignored. I mean they were trying,
Speaker 2: but I just don't feel like there was a lot
Speaker 2: of new knowledge coming out for a while.
Speaker 5: Yeah.
Speaker 4: No, And I think there's a lot of really interesting
Speaker 4: things going on now.
Speaker 3: There's a new.
Speaker 4: Non hormonal treatment for hot flushes called Veoza, which is great.
Speaker 4: That's wonderful if you really have contraindications to using hormones
Speaker 4: and you're having lots of hot flushes, so I think there's.
Speaker 3: Lots of interesting things happening.
Speaker 4: It's a much better time to be a woman in
Speaker 4: your forties or fifties than it was twenty years ago.
Speaker 2: I think, yay, good timing for us. Well, Doctor Gillian,
Speaker 2: thank you so much for coming on. Tell our listeners
Speaker 2: a little bit about hot Flash before you head off,
Speaker 2: because I have a feeling it's going to be of
Speaker 2: interest to at least some of them in our wonderful
Speaker 2: age range.
Speaker 3: Yeah.
Speaker 4: So, Hot Flash is a weekly newsletter that is under
Speaker 4: the Parent Data by Emily Oster Umbrella.
Speaker 3: So Parent Data is Emily Auster's.
Speaker 4: Newsletter that she puts out regularly about data for pregnancy
Speaker 4: and early childhood. Hot Flash is an extension of that
Speaker 4: really focused on the years after you're done having your kids,
Speaker 4: your forties and fifties, just exactly what we've been talking
Speaker 4: about today, and our goal there is really to provide
Speaker 4: evidence based analysis of different topics just like those we've
Speaker 4: been talking about today, where the focus is really making
Speaker 4: sure that we're breaking down the data and helping you
Speaker 4: to make better decisions and helping you to have a
Speaker 4: better conversation with your doctor about your symptoms and what
Speaker 4: you're experiencing as a woman in your forties or fifties.
Speaker 2: Awesome, Well, thank you so much for coming on. This
Speaker 2: has been a very instructive conversation. I'll I'll have to
Speaker 2: kind of bookmarkt and remember to re listen as symptoms
Speaker 2: crop up as they as I'm sure they will.
Speaker 3: So thank you again, my pleasure. So we are back.
Speaker 1: That was awesome listening to doctor Gillian Goddard talk about
Speaker 1: perimenopause and other hormonal related topics. So exciting to get
Speaker 1: more information on that. So today's question comes from a
Speaker 1: listener who is interested in financial topic. She says, you've
Speaker 1: both mentioned your family upbringing with regards to money. I mean,
Speaker 1: just spoiler alert, both very middle class sort of upbringing.
Speaker 1: She finds the conversations about how you've learned to use
Speaker 1: money some of the most interested. I'm specifically interested in
Speaker 1: your philanthropy plans as you are talking about leveling up
Speaker 1: and doing more with that, and also any resources for
Speaker 1: getting into angel investing, because she has no idea where
Speaker 1: to start. So Sarah, maybe you can talk a little
Speaker 1: bit about the giving side of this, because I know
Speaker 1: you guys have been a little bit more organized in
Speaker 1: terms of your budgeting categories and stuff like that.
Speaker 2: Yeah, so we use the software. You need a budget,
Speaker 2: and giving is just one of the categories, just like
Speaker 2: anything else. So the way you need a budget works
Speaker 2: is every single month you create your budget. So I'll say, okay,
Speaker 2: I want to give. I need to put two hundred
Speaker 2: in my electric bill budget or whatever. And then you know,
Speaker 2: I have a category for gifts, which is like birthday gifts,
Speaker 2: and then all kinds of other things including giving, and
Speaker 2: I just dump a standard amount in there every month,
Speaker 2: but it accumulates, so I don't necessarily need to say like, oh,
Speaker 2: I'm gonna give X dollars every single month, and I'm
Speaker 2: gonna give you know, to a different cause. We don't
Speaker 2: do it that way. Instead, we just kind of like
Speaker 2: put the same amount in every month, and then when
Speaker 2: something comes up that seems worthwhile, we can just be like, ooh,
Speaker 2: let's like give a bigger contribution and empty out this
Speaker 2: category to whatever. So like, for an example, recently, I
Speaker 2: just got some like email, as one does, from a
Speaker 2: cause that was like, oh, I'm gonna triple donations. It
Speaker 2: was like an anti gun violence type of thing, and
Speaker 2: it was it was Bloomberg who said he would triple
Speaker 2: all the donations. I was like, you know what, our
Speaker 2: donation will go three times as far if I do
Speaker 2: it now. So let's just empty the category out. I
Speaker 2: you know, wanted to donate to that, and so we
Speaker 2: did it. Sometimes it'll be like, you know, a disaster
Speaker 2: happens and we'll be like, oh, let's let's give to
Speaker 2: this to help these victims of whatever just happen, et cetera.
Speaker 2: And so you know, we're not like huge philanthropists. It's
Speaker 2: not some giant chunk of our income. I see it
Speaker 2: kind of as twofold, like we give some now, and
Speaker 2: then I also hope too, as we accumulate more money
Speaker 2: at have it invested money and our secure in our
Speaker 2: future to give even more later out of what we've invested.
Speaker 2: So that's kind of how we do it. It's not
Speaker 2: super super systematic.
Speaker 3: But it works.
Speaker 2: And I like having a category that's just dedicated to that.
Speaker 2: It's kind of similar to holiday, Like I like to
Speaker 2: collect the money throughout the year and then use it.
Speaker 2: And I liked for their whenever a cause comes up,
Speaker 2: like we have money in there, we can give it
Speaker 2: and feel really good about that, but also know we've
Speaker 2: budgeted for it.
Speaker 1: Yeah, I think this is the kind of thing that
Speaker 1: it just pays to put some thought into it. So
Speaker 1: especially as you're in kind of the wealth accumulation, although
Speaker 1: maybe you're not, maybe you're totally into the giving it
Speaker 1: away stage at this point of your life, but you know,
Speaker 1: be thinking about what causes really inspire you. And I mean,
Speaker 1: I know there's a sort of utilitarian argument of like,
Speaker 1: give it to the thing where it can go the
Speaker 1: furthest and there's something to that, but there's also so
Speaker 1: many problems in the world that you want a cause
Speaker 1: that inspires you and so because then you'll keep giving
Speaker 1: to it and you'll get involved with it personally and
Speaker 1: use whatever social capital you have as well to make
Speaker 1: a difference in that. So really be thinking about what
Speaker 1: inspires you, like, what causes make you think like this
Speaker 1: is a change I'd like to see in the world
Speaker 1: beyond the lookout for ones where again most of us
Speaker 1: are not going to be giving billions away, so we're
Speaker 1: looking for ones where maybe a smaller amount of money
Speaker 1: could make a significant difference. So maybe that's because it's
Speaker 1: something local, right, you can make a big difference in
Speaker 1: your own local community. But start really thinking about these things,
Speaker 1: having a conversation with your partner if you have one,
Speaker 1: and then thinking about like what amount of money would
Speaker 1: we be interested in giving to make a difference in this.
Speaker 1: And I'm with Sarah that I think you're better off
Speaker 1: giving a bigger amount to a smaller number of things
Speaker 1: versus a small amount to a lot of things, partly
Speaker 1: just because it keeps you very invested in that small
Speaker 1: number of things. So you then follow the topics and
Speaker 1: if you're working with a nonprofit, you might get involved,
Speaker 1: you might get on their board or whatever else like that.
Speaker 1: Not an investing podcast, so I don't think you want
Speaker 1: to get all your invested you know, angel investing information
Speaker 1: from here, but I will just do a quick discussion
Speaker 1: of it for anyone who is looking into this. So
Speaker 1: to invest in private companies, so ones that are not
Speaker 1: publicly traded, and in startups and things like that, you
Speaker 1: basically either need to know the founder or you need
Speaker 1: to be what they call here in the US and
Speaker 1: a credited investor, which means that you are well off
Speaker 1: enough that the financial authorities assume you are a big
Speaker 1: girl and can look it into it on your own
Speaker 1: right that you're not going to be devastated if you
Speaker 1: lose your investment. So there's a certain income requirement or
Speaker 1: a certain net worth requirement minus your primary residence. It's high,
Speaker 1: but it's not billionaire high. Again, so there's probably a
Speaker 1: reasonable number of people listening to this whose households income
Speaker 1: wise or net worth would fit into it. As for
Speaker 1: finding companies to invest in, I mean, this is networking
Speaker 1: like anything else. It's probably going to be former colleagues
Speaker 1: of yours, for instance, who have gone the startup route,
Speaker 1: and you get a business plan from them and think
Speaker 1: it looks good, and you put a small amount of
Speaker 1: money into.
Speaker 3: It, maybe people you went to school with.
Speaker 1: If you are in a reasonable sized city or near
Speaker 1: a university, there might be you know, investing organizations that
Speaker 1: various entrepreneurs can come pitch their idea too, and people
Speaker 1: ask questions and then you can see what looks good
Speaker 1: and all that. But as you start doing it, as
Speaker 1: you make small investments in small companies, founders will hear
Speaker 1: about you too, and so they will come and you know,
Speaker 1: you'll start getting pitches and then you can evaluate what
Speaker 1: do I think will grow? What do I think has
Speaker 1: a reasonable exit strategy so that I, you know, would
Speaker 1: hopefully make my money back, although again with this you're
Speaker 1: probably not going to make your money back on the
Speaker 1: vast majority of them. The ideas that maybe you know,
Speaker 1: one in twenty might return twenty x and then you're
Speaker 1: even or something are slightly ahead. So it's just more
Speaker 1: of a fun way to get involved in investing, and
Speaker 1: so again not an investing podcast, but there are plenty
Speaker 1: of ones out there that are, so you know, recommend
Speaker 1: you kind of google that and get the basics if
Speaker 1: you are interested. Well, this has been best of both worlds.
Speaker 1: Sarah was interviewing doctor Gillian Goddard about perimenopause and related topics.
Speaker 1: We will be back next week with more on making
Speaker 1: work and life fit together.
Speaker 2: Thanks for listening. You can find me Sarah at the
Speaker 2: shoebox dot com or at the Underscore Shoebox on Instagram,
Speaker 2: and you.
Speaker 1: Can find me Laura at Laura vandercam dot com. This
Speaker 1: has been the best of both worlds podcasts. Please join
Speaker 1: us next time for more on making work and life
Speaker 1: work together.